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Flashcards in exam pt 3 Deck (42)
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1
Q

after a TBI to the dorsolateral aspect of the prefrontal area, what deficits would you expect?

A

impaired concentration, possibly decreased motivation & problem solving

2
Q

after a TBI to the premotor aspect of the frontal lobe, what characteristics would you expect a patient to display?

A

apraxia or motor planning deficits

3
Q

If a patient is displaying unstable emotions and/or unpredictable behaviors, you may suspect damage to..

A

the orbitofrontal aspect of the frontal lobe

4
Q

If a patient sustains damage to the SMA, what characteristics would you expect them to display?

A

loss of b/l control of posture

5
Q

If a patient sustains damage to teh primary motor cortex during a TBI, what characteristics would you expect them to display?

A

contralateral paralysis and paresis, most pronounced in distal parts of limbs and lower part of face

6
Q

if, after a TBI, a patient has difficulty with conjugate eye movements to the right, you would expect an injury to..

A

the LEFT middle frontal gyrus of the frontal lobe

7
Q

after a concussion, a patient will have impaired functioning of the ..

A

brainstem reticular activating system

8
Q

To be classified as a severe TBI, a patient will have lost consciousness for..

A

>24 hours (GCS score of <9)

9
Q

If, after a TBI, a patient demonstrates visuospatial or body scheme disorders, they most likely have a lesion in the..

A

R hemisphere of the parietal lobe

10
Q

LOCF =

A

Rancho Los Amigos Level of Cognitive Functioning

11
Q

If after a TBI a patient has an impairment of taste in the contralateral side of the tongue, they most likely have a lesion..

A

in the gustatory cortex of the parietal lobe

12
Q

a lesion where would cause a patient to have profound memory loss of recent events & no new learning?

A

parahippocampal region of the temporal lobe

13
Q

If a patient is at LOCF IV-VI, what would be your focus and emphasis for their care?

A
  1. provide structure, avoid overstimulation if agitated/confused
  2. use daily schedules & memory logs

3. provide consistency, give clear feedback

  1. use task-specific training, but limit your activities to well-liked, familiar ones

5. provide freq orientation to time, place, etc

6. emphasize safety, behavioral mgmt

14
Q

what is the most severe ASIA level?

A

ASIA A - complete, no motor or sensory function is preserved in the sacral segments S4-5

15
Q

the level of an SCI indicates..

A

the most distal uninvolved nerve root segment with normal function

-muscles MUST have at least a grade of 3+/5

16
Q

a C6 ASIA C patient would p/w..

A

Motor function below C7 is preserved but most ms have <3/5 grade

17
Q

what type of SCI is considered a LMN lesion?

A

cauda equina injury (loss of long nerve roots at or below L1)

-flaccid paralysis w NO spinal reflex, also bladder and bowel paralysis

-regeneration is SLOW, often INCOMPLETE; stops after about 1 year

18
Q

what is the result of Brown-Sequard syndrome?

A

IPSIlaterally :

-loss of dorsal columns w loss of tactile discrimination, pressure, vibration and proprioception

-loss of corticospinal tracts with loss of motor fxn & spastic paralysis below level of lesion

Contralaterally:

-spinothalamic tract loss w loss of pain and temp; b/l loss of pain & temp at level of lesion

19
Q

with a central cord lesion, what is preserved?

A

proprioception and discriminatory sensation

  • loss of spinothalamic tracts with b/l loss of pain and temp
  • loss of ventral horn w b/l loss of motor fxn (primarily UEs)
20
Q

what nerves innervate the diaphragm?

A

C3-5 (ie if a lesion is above C4, respiratory insufficiency or failure occurs)

21
Q

If a patient with an SCI p/w increased spasticity/spasms, what could be the likely cause?

A

look for nociceptive stimuli that may trigger the increased tone (i.e. blocked cather, tight clothing/straps, body position, environ temp, infection or decubitus ulcers)

22
Q

what are the symptoms of autonomic dysreflexia?

A

1. paroxysmal HTN 2. bradycardia 3. HA

4. sweating (diaphoresis) 5. flushing 6. diplopia

  1. convulsions
    - FIRST: elevate head, check & empty catheter
23
Q

what is spinal shock

A

a transient period lasting anywahere from several hours to 24 weeks; involves reflex depression & flaccidity

24
Q

for patients with high cervical lesions, the most ideal w/c would be:

A

electric w/c w tilt in space OR reclining seat back,

-microswitch OR puff-and-sip controls

-possibly a portable respirator

25
Q

If a patient has a cervical lesion SCI with at least shoulder function & elbow flexion (C5), what type of w/c is recommended?

A

manual chair w propulsion aids

-indep for short distances on smooth flat surfaces

-may choose electric w/e for distance/nrg conservation

26
Q

what w/c is recommended for someone with a C6 SCI?

A

they still have radial wrist extensors, so a manual w/c with friction surface hand rims (independently)

27
Q

If a patient has a C7 SCI, the w/c recommended is..

A

manual w/c with friction handrims with increased propulsion

28
Q
A
29
Q

what kind of ambulation is expected of a midthoracic lesion SCI (T6-9)?

A

supervised ambulation for short distances

-req b/l KAFOs and crutches, swing to pattern,

30
Q

what type of gait is expected of a high lumbar lesion SCI (T12-L3)?

A

**maintained: hip flex, knee ext

independent ambulators on all surfaces and stairss using a swing thru OR four-point gait pattern & B/L KAFOs and crutches

31
Q

what type of gait would you expect from an SCI patient with a low lumbar lesion (L4-L5)?

A

maintained: DF, g toe ext

independent w b/l AFOs and crutches or canes

typically are indep community ambulators

32
Q

what are CV precautions associated with tetraplegia & high-lesion paraplegia?

A
  1. blunted tachycardia
  2. lack of pressor response
  3. very low VO2 peak
  4. higher variability of responses
33
Q

ABSOLUTE contraindications to exercise with SCI patients

A

1. autonomic dysreflexia

2. UTI

3. symptomatic hypotension

4. Unstable fx

5. insufficient ROM to perform task

6. severe/infected skin on WBing surface

7. Uncontrolled hot/humid environments

34
Q

what does BWSTT do for a patient with an incomplete SCI?

A

promotes spinal cord learning/activation of spinal locomotor pools

35
Q

what is the freq/duration of BWSTT suggested for incomplete SCIs?

A

4x/week x20-30 minutes

(8-12 weeks)

36
Q

some precipitating or exacerbating factors of MS would be..

A

infections, trauma, pregnancy & stress

37
Q

diagnostic tests for MS =?

A
  1. LP/CSF
  2. elevated gamma globulin
  3. CT or MRI
  4. myelogram
  5. EEG
38
Q

what types of sensory differences might be found in a patient with MS?

A
  1. hyperpathia (hypersensitivity to sensory stimuli)
  2. dysesthesias (abnormal sensations)
  3. trigeminal neuralgia
  4. Lhermitte’s sign
39
Q

what’s the EDSS and what patient population is it used for?

A

expanded disability status scale

-outcome measure for MS

40
Q

what pharmacological intervention is used during an acute flair up

A

immunosuppressant drugs ie ACTH & steroids

41
Q

what drugs are used in MS to slow the progression of the disease?

A

interferon drugs

42
Q
A